Download Treatment for Alcohol Problems: Finding and Getting Help

Treatment for
Alcohol Problems:
Finding and
Getting Help
This guide is written for individuals,
and their family and friends, who
are looking for options to address
alcohol problems. It is intended
as a resource to understand what
treatment choices are available
and what to consider when selecting
among them.
Table of Contents
When Is It Time for Treatment?
2
Options for Treatment
4
Treatments Led by Health Professionals
6
What FDA-Approved Medications Are Available?
8
Tips for Selecting Treatment
10
An Ongoing Process
12
Resources
14
1
When Is It Time for Treatment?
Alcohol-related problems — which result from drinking too much,
too fast, or too often — are among the most significant public
health issues in the United States.
Many people struggle with controlling their drinking at some time in their lives. Approximately
17 million adults ages 18 and older have an alcohol use disorder (AUD) and 1 in 10
children live in a home with a parent who has a drinking problem.
Does Treatment Work?
The good news is that no matter how severe the problem may seem, most
people with an alcohol use disorder can benefit from some form of treatment.
Research shows that about one-third of people who are treated for alcohol
problems have no further symptoms 1 year later. Many others substantially
reduce their drinking and report fewer alcohol-related problems.
2
Signs of an Alcohol Problem
Alcohol use disorder (AUD) is a medical condition that doctors diagnose
when a patient’s drinking causes distress or harm. The condition can range
from mild to severe and is diagnosed when a patient answers “yes” to two
or more of the following questions.
In the past year, have you:
❏ Had times when you ended up drinking more, or longer than you intended?
❏ More than once wanted to cut down or stop drinking, or tried to, but
couldn’t?
❏ Spent a lot of time drinking? Or being sick or getting over the aftereffects?
❏ Experienced craving — a strong need, or urge, to drink?
❏ Found that drinking — or being sick from drinking — often interfered
with taking care of your home or family? Or caused job troubles?
Or school problems?
❏ Continued to drink even though it was causing trouble with your family
or friends?
❏ Given up or cut back on activities that were important or interesting
to you, or gave you pleasure, in order to drink?
❏ More than once gotten into situations while or after drinking that
increased your chances of getting hurt (such as driving, swimming,
using machinery, walking in a dangerous area, or having unsafe sex)?
❏ Continued to drink even though it was making you feel depressed or
anxious or adding to another health problem? Or after having had a
memory blackout?
❏ Had to drink much more than you once did to get the effect you want?
Or found that your usual number of drinks had much less effect than before?
❏ Found that when the effects of alcohol were wearing off, you had withdrawal
symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression,
restlessness, nausea, or sweating? Or sensed things that were not there?
If you have any of these symptoms, your drinking may already be a cause
for concern. The more symptoms you have, the more urgent the need for
change. A health professional can conduct a formal assessment of your symptoms
to see if an alcohol use disorder is present. For an online assessment of your
drinking pattern, go to RethinkingDrinking.niaaa.nih.gov.
3
Options for Treatment
When asked how alcohol problems are treated, people commonly think
of 12-step programs or 28-day inpatient rehab, but may have difficulty
naming other options. In fact, there are a variety of treatment methods
currently available, thanks to significant advances in the field over
the past 60 years.
Ultimately, there is no one-size-fits-all solution, and what may work for one person
may not be a good fit for someone else. Simply understanding the different options
can be an important first step.
Types of Treatment
Behavioral Treatments
Behavioral treatments are aimed at changing drinking behavior through counseling.
They are led by health professionals and supported by studies showing they can
be beneficial.
Medications
Three medications are currently approved in the United States to help people
stop or reduce their drinking and prevent relapse. They are prescribed by a
primary care physician or other health professional and may be used alone or
in combination with counseling.
Mutual-Support Groups
Alcoholics Anonymous (AA) and other 12-step programs provide peer support
for people quitting or cutting back on their drinking. Combined with treatment
led by health professionals, mutual-support groups can offer a valuable added
layer of support.
Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.
4
Starting With a Primary Care Doctor
For anyone thinking about treatment, talking to a primary care physician is an
important first step — he or she can be a good source for treatment referrals
and medications. A primary care physician can also:
•
Evaluate whether a patient’s drinking pattern is risky
•
Help craft a treatment plan
•
Evaluate overall health
•
Assess if medications for alcohol may be appropriate
Types of Professionals Involved in Care
Many health professionals can play a role in treatment. Below is a list of
providers and the type of care they may offer.
Provider
Type
Degrees
& Credentials
Treatment
Type
Primary Care
Provider
M.D., D.O. (Doctor of
Osteopathic Medicine),
additionally you may see
a Nurse Practitioner or
Physician’s Assistant
Medications, Brief
Behavioral Treatment,
Referral to Specialist
Psychiatrist
M.D., D.O.
Medications,
Behavioral Treatment
Psychologist
Ph.D., Psy.D., M.A.
Behavioral Treatment
Social Worker
M.S.W. (Master of Social
Work), L.C.S.W. (Licensed
Clinical Social Worker)
Behavioral Treatment
Alcohol
Counselor
Varies—most States require
some form of certification
Behavioral Treatment
Individuals are advised to talk to their doctors about the best form of primary
treatment.
5
Treatments Led by Health Professionals
Professionally led treatments include:
Medications
Some are surprised to learn that there
are medications on the market
approved to treat alcohol dependence.
The newer types of these medications
work by offsetting changes in the
brain caused by alcoholism.
All approved medications are non­
addictive and can be used alone or
in combination with other forms of
treatment. Learn more about these
approved treatments on p. 8.
Behavioral Treatments
Also known as alcohol counseling, behavioral treatments involve working with a health
professional to identify and help change the behaviors that lead to heavy drinking.
Behavioral treatments share certain features, which can include:
• Developing the skills needed to stop
or reduce drinking
• Helping to build a strong social
support system
• Working to set reachable goals
• Coping with or avoiding the
triggers that might cause relapse
6
Types of Behavioral Treatments
• Cognitive–Behavioral Therapy can take place one-on-one with a therapist
or in small groups. This form of therapy is focused on identifying the feelings
and situations (called “cues”) that lead to heavy drinking and managing
stress that can lead to relapse. The goal is to change the thought processes
that lead to excessive drinking and to develop the skills necessary to cope
with everyday situations that might trigger problem drinking.
• Motivational Enhancement Therapy is conducted over a short period
of time to build and strengthen motivation to change drinking behavior.
The therapy focuses on identifying the pros and cons of seeking treatment,
forming a plan for making changes in one’s drinking, building confidence,
and developing the skills needed to stick to the plan.
• Marital and Family Counseling incorporates spouses and other family
members in the treatment process and can play an important role in
repairing and improving family relationships. Studies show that strong
family support through family therapy increases the chances of maintaining
abstinence (stopping drinking), compared with patients undergoing
individual counseling.
• Brief Interventions are short, one-on-one or small-group counseling
sessions that are time limited. The counselor provides information
about the individual’s drinking pattern and potential risks. After receiving
personalized feedback, the counselor will work with the client to set goals
and provide ideas for helping to make a change.
Ultimately, choosing to get treatment may be more important than the approach
used, as long as the approach avoids heavy confrontation and incorporates empathy,
motivational support, and a focus on changing drinking behavior.
7
What FDA-Approved Medications Are Available?
Certain medications have been shown to effectively help people
stop or reduce their drinking and avoid relapse.
Current Medications
The U.S. Food and Drug Administration (FDA) has approved three medications
for treating alcohol dependence, and others are being tested to determine if they
are effective.
• Naltrexone can help people reduce
heavy drinking.
• Acamprosate makes it easier to
maintain abstinence.
• Disulfiram blocks the breakdown
(metabolism) of alcohol by the body,
causing unpleasant symptoms such
as nausea and flushing of the skin.
Those unpleasant effects can help
some people avoid drinking while
taking disulfiram.
It is important to remember that not all people will respond to medications,
but for a subset of individuals, they can be an important tool in overcoming
alcohol dependence.
Scientists are working to develop a larger menu of pharmaceutical treatments
that could be tailored to individual needs. As more medications become available,
people may be able to try multiple medications to find which they respond to best.
“Isn’t taking medications just trading one addiction
for another?”
This is not an uncommon concern, but the short answer is “no.” All medications
approved for treating alcohol dependence are non-addictive. These medicines
are designed to help manage a chronic disease, just as someone might take
drugs to keep their asthma or diabetes in check.
8
Looking Ahead: The Future of Treatment
Progress continues to be made as researchers seek out new and better treatments for
alcohol problems. By studying the underlying causes of alcoholism in the brain and
body, NIAAA is working to identify key cellular or molecular structures — called “targets” —
that could lead to the development of new medications.
Personalized Medicine
Ideally, health professionals would be able to identify which alcoholism treatment is
most effective for each person. NIAAA and other organizations are conducting research
to identify genes and other factors that can predict how well someone will respond to
a particular treatment. These advances could optimize how treatment decisions are
made in the future.
Current NIAAA Research — Leading to Future Breakthroughs
Certain medications already approved for other uses have shown promise for
treating alcohol dependence and problem drinking:
• The anti-smoking drug varenicline (marketed under the name Chantix)
significantly reduced alcohol consumption and craving among people
with alcoholism.
• Gabapentin, a medication used to treat pain conditions and epilepsy, was
shown to increase abstinence and reduce heavy drinking. Those taking the
medication also reported fewer alcohol cravings and improved mood and sleep.
• The anti-epileptic medication topiramate was shown to help people curb
problem drinking, particularly among those with a certain genetic makeup
that appears to be linked to the treatment’s effectiveness.
9
Tips for Selecting Treatment
Professionals in the alcohol treatment field offer advice on what to
consider when choosing a treatment program.
Overall, gather as much information as you can about the program or provider before
making a decision on treatment. If you know someone who has first-hand knowledge
of the program, it may help to ask about his or her personal experience.
Here are some questions you can ask that may help guide your choice:
❏ What kind of treatment does the program or provider offer?
It is important to gauge if the facility provides all the currently available
methods or relies on one approach. You may want to learn if the program
or provider offers medication and if mental health issues are addressed
together with addiction treatment.
❏ Is treatment tailored to the individual?
Matching the right therapy to the individual is important to its success. No
single treatment will benefit everyone. It may also be helpful to determine
whether treatment will be adapted to meet changing needs as they arise.
❏ What is expected of the patient?
You will want to understand what will be asked of you in order to decide
what treatment best suits your needs.
❏ Is treatment success measured?
By assessing whether and how the program or provider measures success,
you may be able to better compare your options.
❏ How does the program or provider handle relapse?
Relapse is common and you will want to know how it is addressed. For more
information on relapse, see p. 12.
When seeking professional help, it is important you feel respected and understood
and that you have a feeling of trust that this person, group, or organization can help
you. Remember, though, that relationships with doctors, therapists, and other health
professionals can take time to develop.
10
Additional Considerations
Treatment Setting — Inpatient or Outpatient?
In addition to choosing the type of treatment that’s best for you, you’ll also have to
decide if that treatment is inpatient (you would stay at a facility) or outpatient (you stay
in your home during treatment). Inpatient facilities tend to be more intensive and costly.
Your health care provider can help you evaluate the pros and cons of each.
Cost may be a factor
when selecting a treatment
approach. Evaluate the
coverage in your health
insurance plan to determine
how much of the costs your
insurance will cover and how
much you will have to pay.
Ask different programs if
they offer sliding scale fees
— some programs may offer
lower prices or payment
plans for individuals without
health insurance.
11
An Ongoing Process
Overcoming an alcohol use disorder is an ongoing process, one
which can include setbacks.
The Importance of Persistence
Because an alcohol use disorder can be a chronic relapsing disease, persistence is key.
It is rare that someone would go to treatment once and then never drink again. More
often, people must repeatedly try to quit or cut back, experience recurrences, learn
from them, and then keep trying. For many, continued followup with a treatment
provider is critical to overcoming problem drinking.
Relapse Is Part of the Process
Relapse is common among people who overcome alcohol problems. People with drinking
problems are most likely to relapse during periods of stress or when exposed to people
or places associated with past drinking.
Just as some people with diabetes or asthma may have flare-ups of their disease,
a relapse to drinking can be seen as a temporary set-back to full recovery and not a
complete failure. Seeking professional help can prevent relapse — behavioral therapies
can help people develop skills to avoid and overcome triggers, such as stress, that
might lead to drinking. Most people benefit from regular checkups with a treatment
provider. Medications also can deter drinking during times when individuals may be
at greater risk of relapse (e.g., divorce, death of a family member).
Mental Health Issues and Alcohol Use Disorder
Depression and anxiety often go hand in hand with heavy drinking. Studies show
that people who are alcohol dependent are two to three times as likely to suffer
from major depression or anxiety over their lifetime. When addressing drinking
problems, it’s important to also seek treatment for any accompanying medical
and mental health issues.
12
Advice For Friends and Family Members
Caring for a person who has problems with alcohol can be very stressful. It is important
that as you try to help your loved one, you find a way to take care of yourself as well.
It may help to seek support from others, including friends, family, community, and
support groups. If you are developing your own symptoms of depression or anxiety,
think about seeking professional help for yourself. Remember that your loved one is
ultimately responsible for managing his or her illness.
However, your participation can make a big difference. Based on clinical experience,
many health providers believe that support from friends and family members is important
in overcoming alcohol problems. But friends and family may feel unsure about how
best to provide the support needed. The groups for family and friends listed on p. 14
may be a good starting point.
Remember that changing deep habits is hard, takes time, and requires repeated
efforts. We usually experience failures along the way, learn from them, and then keep
going. Alcohol use disorders are no different. Try to be patient with your loved one.
Overcoming this disorder is not easy or quick.
Pay attention to your
loved one when he or
she is doing better or
simply making an effort.
Too often we are so angry
or discouraged that we
take it for granted when
things are going better.
A word of appreciation
or acknowledgement of a
success can go a long way.
13
Resources
Professional help
Your doctor. Primary care and mental health
practitioners can provide effective alcoholism
treatment by combining new medications
with brief counseling visits. To aid clinicians,
NIAAA has developed two guides: Helping
Patients Who Drink Too Much, and for
younger patients, Alcohol Screening and Brief
Interventions for Youth: A Practitioner’s Guide.
Both are available at www.niaaa.nih.gov/
publications/clinical-guides-and-manuals
Specialists in alcohol use disorders. For
specialty addiction treatment options, contact
your doctor, health insurance plan, local health
department, or employee assistance program.
Other resources include:
Medical and non-medical
addiction specialists
American Academy of Addiction Psychiatry
www.aaap.org 401–524–3076 American Psychological Association
www.apa.org 1–800–964–2000 (ask for your State’s referral number to find psychologists with addiction specialties)
American Society of Addiction Medicine www.asam.org 301–656–3920 (ask for the phone number of your State’s chapter)
NAADAC Substance Abuse Professionals
www.naadac.org 1–800–548–0497 National Association of Social Workers
www.helpstartshere.org (search for social workers with addiction specialties)
14
Treatment facilities
Substance Abuse Treatment Facility Locator www.findtreatment.samhsa.gov 1–800–662–HELP
Mutual-support groups
Alcoholics Anonymous (AA)
www.aa.org
212–870–3400 or check your local
phone directory under “Alcoholism”
Moderation Management
www.moderation.org 212–871–0974 Secular Organizations for Sobriety
www.sossobriety.org 323–666–4295 SMART Recovery
www.smartrecovery.org 440–951–5357 Women for Sobriety
www.womenforsobriety.org 215–536–8026
Groups for family and friends
Al-Anon Family Groups
www.al-anon.alateen.org 1–888–425–2666 for meetings Adult Children of Alcoholics
www.adultchildren.org 310–534–1815
Information resources
National Institute on Alcohol Abuse
and Alcoholism
www.niaaa.nih.gov 301–443–3860
National Institute on Drug Abuse
www.nida.nih.gov 301–443–1124
National Institute of Mental Health
www.nimh.nih.gov 1–866–615–6464 National Clearinghouse for Alcohol
and Drug Information
www.samhsa.gov 1–800–729–6686
Research shows that most
people who have alcohol
problems are able to reduce
their drinking or quit entirely.
There are many roads to
getting better. What is
important is finding yours.
Understanding the available
treatment options — from
behavioral therapies and
medications to mutual-support
groups — is the first step. The
important thing is to remain
engaged in whatever method
you choose.
Ultimately, receiving treatment
can improve your chances
of success.
15
Notes 16
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM
NIH . . . Turning Discovery Into Health
NIH Publication No. 14–7974
Published 2014